Women In Rural South Africa Research Articles

Adverse mental health outcomes associated with emotional abuse in young rural South African women: a cross-sectional study.

There is a lack of data on the prevalence of emotional abuse in youth. The aim of this study was thus to estimate the prevalence of emotional abuse in intimate partnerships among young women in rural South Africa and to measure the association between lifetime experience of emotional abuse (with and without the combined experience of physical and/or sexual abuse) and adverse health outcomes. Between 2002 and 2003, young women from 70 villages were recruited to participate in the cluster randomized controlled trial of an HIV behavioral intervention, Stepping Stones. Data was obtained through the administration of a questionnaire at baseline. Of the 1,293 women who had ever been partnered, 189 (14.6%) had experienced only emotional abuse in their lifetimes. Three hundred sixty-six women (28.3%) experienced emotional abuse with physical and/or sexual abuse in their lifetimes, and one hundred forty-four women (11.1%) experienced physical and/or sexual abuse without emotional abuse. Hazardous drinking was associated with the experience of physical and/or sexual abuse, with (OR 6.0, 95% CI [1.0, 36.6]) and without emotional abuse (OR 5.8, 95% CI [1.1, 29.4]). Illicit drug use (OR 5.6, 95% CI [2.4, 12.6]), having depressive symptoms (OR 2.9, 95% CI [1.2, 4.2]), having psychological distress (OR 1.9, 95% CI [1.4, 2.6]), and suicidality (OR 79.0, 95% CI [17.3, 359.6]) was associated with the experience of emotional abuse with physical and/or sexual abuse. Suicidality was also strongly associated with having experienced emotional abuse alone (OR 79.5, 95% CI [16.7, 377.4]). This study showed that emotionally abused young women had a greater risk of suicidality than those experiencing no abuse and that the combined experience of emotional with physical and/or sexual abuse was strongly associated with poor mental health outcomes.

Screening for ‘window‐period’ acute HIV infection among pregnant women in rural South Africa

The aim of this study was to evaluate the HIV-1 RNA pooled nucleic acid amplification testing (NAAT) strategy to screen pregnant women in the 'window period' of acute HIV infection (AHI) in rural South Africa. In 2007 and 2008, 750 consecutive pregnant women on their first antenatal care visit to a primary health care clinic were tested anonymously for HIV infection. HIV-1 RNA pooled NAAT was performed on HIV antibody-negative samples. All positive pools were tested individually and positive samples were classified as incident cases to calculate HIV incidence. The overall HIV prevalence was 37.3% [95% confidence interval (CI) 34.3–41.3]. Of the 467 HIV antibody-negative samples, four (0.9%) were HIV-1 RNA-positive. The mean viral load in the four samples was 386 260 HIV-1 RNA copies/mL (range 64 200–1 228130). The HIV incidence was 11.2%per year (95% CI 0.3–22.1) and all women with AHI were 21 years of age. Identifying AHI in pregnancy is important for health interventions to reduce perinatal and heterosexual transmission of HIV, and to estimate HIV incidence for epidemiological surveillance.

Investigating the well-being of rural women in South Africa

abstract In this Focus piece we explore differences in the well-being of men and women in rural and urban areas. We use quantitative data from a nationally representative household survey in 2008 to measure income poverty and access to services in the households that men and women live in. In addition, we complement this analysis with a range of subjective measures of well-being collected in the survey, which allow us to identify differences in the lived experiences of men and women within their households. We find that, according to both the objective and subjective measures of well-being that we explore, African women living in rural areas are the most disadvantaged group in South Africa.

Access to ICT education for girls and women in rural South Africa: A case study

This paper describes the impact of socio-economic factors on girls and women's access to Information and Communication Technology (ICT) education and training in a rural South African environment and recommends strategies for improved access to ICT education and training. The study was undertaken through a case study conducted in the Moutse village in the Elandsdoorn area of Mpumalanga province, South Africa.

Transformation through training: application of emancipatory methods in a housing education programme for rural women in South Africa

The role of education in the development of communities has been receiving increasing attention from the South African Government. The purpose of this study was to determine how community developers could contribute to transformative learning in community groups. Using an emancipatory teaching approach, a housing education programme was presented to a group of women who had recently been allocated subsidized housing in a rural Northern Cape town in South Africa. During the implementation of the housing intervention, the emancipatory method encouraged participants to question and alter their distorted assumptions. Guidelines are provided for community developers for applying the emancipatory teaching method to facilitate transformative learning.

High prevalence of abnormal Pap smears among young women co-infected with HIV in rural South Africa - implications for cervical cancer screening policies in high HIV prevalence populations.

To establish the relationship between HIV infection and cervical dysplasia in young women in rural South Africa. This cross-sectional study was conducted at a primary health care clinic in Vulindlela, KwaZulu- Natal. Standardised questionnaires were used to collect sociodemographic and clinical presentation data from women attending family planning and other reproductive health services. Pap smears were done using standard methods. Pap smear data were linked to HIV serostatus. Four hundred and sixty-six women were included in the study. The median age was 24.3 years (range 15 - 55 years), and 80% were younger than 30 years. The HIV prevalence rate was 24.5% (95% confidence interval: 20.7 - 28.7%) and the prevalence of abnormal Pap smears was 16.9 - 6.4% ASCUS (atypical squamous cells of undetermined significance), 9.2% LGSIL (low-grade squamous intraepithelial lesions), and 1.3% HGSIL (high-grade squamous intraepithe lial lesions). The association between HIV seropositivity and abnormal Pap results was statistically significant (p < 0.05). There is a need for more data on cervical changes in HIV co-infected women and for review of guidelines on selective Pap smear screening in high HIV prevalence settings such as sub-Saharan Africa and where access to antiretroviral treatment remains limited.

An assessment of women’s access to natural resources through communal projects in South Africa

With the passing of the apartheid regime and its multi-faceted mechanisms of exclusion, women in rural South Africa have begun expanding their access to natural resources for livelihood enhancement. One of the ways this has occurred is through community-based organizations that focus on local production as a mechanism to transform natural resources into material goods. While this practice is nearly ubiquitous throughout sub-Saharan Africa, the apartheid regime was particularly effective in limiting access to natural resources, a phenomenon reversed by the current democratic government. In this paper, we assess the impact of organizational design on women’s livelihood systems as a means of alleviating rural poverty. We surveyed women on both more formal, or bureaucratic, organizations and more informal, or socially-embedded, organizations. After locating the discussion in the relevant gender, environment, and livelihoods literatures, we employ four concepts, organizational context, environmental entitlement, livelihood systems, and gender and power relations to assess the impact of organizational design on livelihood enhancement. Having found that women derived no significant material benefit from participation in either type of organization, we conclude that women are straddling two processes, neo-liberalization and neo-traditionalism, that impact gender and power relations. This situation has left women in vulnerable positions within their organizations and with little livelihood enhancement.

Breast cancer in black African women: a changing situation.

Black African women in rural South Africa have a very low incidence rate of breast cancer, 5-10 per 100,000. The rate, however, is rising in the considerably increasing urban population. During the period 1994 to 1999 in Durban, enquiries revealed an average of 57 urban patients admitted to hospital each year, from a population of about 600,000 African women, indicating an age-adjusted annual incidence rate of 15.1 per 100,000. This incidence rate is very low in comparison with those in developed populations, which range from 40 to 89 per 100,000. In the African patients studied, the mean age on admission was relatively young, 54.1 +/- 10.9 years, almost a decade earlier than patients of developed populations. Moreover, the disease was very far advanced; 21.1% were at Stage III and 63.1% at Stage IV. As to exposure to risk factors, African women in general are characterised by certain protective factors. These factors, which closely resemble those of importance in patients in developed populations are, late menarche, early age at birth of first child, high parity (with usually prolonged lactation), and being physically active. However, with ongoing changes in the lifestyle of urban African women, the protective factors are decreasing in their intensity. Changes in these respects have been associated with rises in the disease's incidence rate. Clearly, because of the late stage of the disease at the time of the patients' admission to hospital, and hence their poor survival rate, intensive efforts should be made to educate women to seek help at an early stage of their disease. For its avoidance, feasible protective or restraining measures are primarily to adopt a 'prudent' lifestyle, in respect of both dietary and non-dietary components. However, the chances of these measures being meaningfully adopted in African urban communities, unfortunately, are negligible. In consequence, further increases in incidence rate would seem inevitable.

Knowledge, attitudes and practices of rural women in South Africa regarding the Pap smear

Cancer of the cervix is the second most common form of cancer amongst South African women and the most common cause of cancer mortality among black South African women. The high incidence is complicated by late presentation for treatment as well as misconceptions. The national South African and provincial Eastern Cape policy guidelines on cervical cancer screening encourages all women to have at least three Pap smears in a lifetime. At present 18 out of the 24 primary health care clinics in the Hewu sub-district of the Eastern Cape have facilities to offer cervical cancer screening but due to lack of manpower this is not done routinely. The aim of this study was to ascertain the knowledge practices and attitudes regarding the Pap smear among women in a typical rural setting. (excerpt)

Why do women seek antenatal care late? Perspectives from rural South Africa

Despite the widespread availability of free antenatal care services, most women in rural South Africa attend their first antenatal clinic late in pregnancy and fail to return for any followup care, potentially leading to avoidable perinatal and maternal complications. Using interviews with pregnant women from the rural Hlabisa district of South Africa, we documented perceptions of health and health care during pregnancy and investigated factors shaping the utilization of antenatal care. Our findings indicate that most women in this setting do not perceive significant health threats during pregnancy, and in turn view more than one antenatal care visit as unnecessary. In contrast, women perceive labour and delivery as a time of significant health risks that require biomedical attention, and most women prefer to give birth in a health facility. This paradox, in which health care is important for childbirth but not during pregnancy, is embodied in most women’s primary reason for seeking antenatal care in this setting: to receive an antenatal attendance card that is required to deliver at a health facility. Health education programs promoting antenatal care are required to explain the importance of effective antenatal care toward maternal and child health.

Women’s Struggle to Escape Rural Poverty in South Africa

Results of a purposive sample of the poorest are contrasted with the methods and conclusions of other research into ‘income poverty’. The deprivation suffered by an important class of rural women in South Africa is documented. Escape routes from poverty are described that have a more realistic prospect of success than those promoted in the international and South African policy literature, including the literature on land reform. The distinguishing demographic characteristics of women who have taken the first steps on these routes are analysed, together with the political context of their relative success. Escaping the worst forms of deprivation depends on women’s wages in rural labour markets, rather than their incomes from self‐employment, but conventional microeconomic theory cannot explain the distribution of wages in these markets. The South African government has been unduly influenced by such conventional theories and the rhetoric of the development aid bureaucracy. It is failing to consider policies that are relevant to the poorest people.

THE INTERSECTION OF GENDER. RACE AND CLASS: THE SOCIO-ECONOMIC AND SPATIAL IMPLICATIONS OF DIFFERENTIATION IN THE FORMER HOMELANDS OF SOUTH AFRICA

ABSTRACT One of the greatest challenges facing a transforming South Africa is the effective integration of the former homelands into the social, economic and political fabric of the rest of the country. In recent years, increasing policies and programmes are aimed at addressing the challenges faced by rural communities located in the former homelands. However, as many studies cited in this article suggest, limited knowledge and understanding of rural communities in the former homelands persist. A fundamental issue that tends to be neglected is that pertaining to gender concerns related to social differentiation within these communities. By drawing on fieldwork conducted in the former homelands of Kwazulu and Lebowa as well as secondary sources; this article examines the links between class, gender and race. More specifically, it explores the various impacts that these associations have on social differentiation amongst poor rural women in South Africa's former homelands.

Telecommunication Policy and Regulation for Women and Development

This paper examines the issue of whether or not the needs and interests of the majority of women who live in poverty are likely to be addressed by current legislative and regulatory measures designed to achieve universal access to telephone service in South Africa. The paper highlights the enabling aspects of the policy and legislative framework to equalise gender relations in the telecommunication sector in South Africa. Particularly, it identifies the empowerment and advancement of women in telecommunications and the ownership and control of telecommunications services by persons from historically disadvantaged groups, as enabling aspects of the Telecommunications Act of 1996.The author concludes that while current measures may positively affect the lives of a relatively small percentage of women through their inclusion in the ownership and control of new companies or from increased employment opportunities or promotion previously denied them in this male dominated sector the current measures are deficient. This is firstly because current policy and implementation strategies do not effectively address issues of affordability. Secondly, the technical features of the network are presumed to be neutral with respect to cost (and price) considerations, masking their class and gender bias. Finally, insufficient attention has been given to seeking innovative ways of addressing women’s information needs which are assumed, from technology design through to service offerings, to be the same as those of men and particularly businessmen.The paper continues to explore possible policy and regulatory strategies that can be pursued under existing conditions within the telecommunications sector in South Africa and in other developing countries to enable the sustainable development of women in society. It is argued in the policy and statutory requirements to promote universal and affordable service to women and that the developmental potential of telecommunications should positively affect the lives of women. From a developmental point of view, the objective of universal service has the potential to be a powerful enabler for a wide range of women. Given that rural women in South Africa, as in other parts of the developing world, are the worst affected by poverty, any strategy to provide universal access and ultimately service, on the grounds of the right to information and potential for social and economic development, must target this most marginalised group.

High HIV Incidence and Prevalence Among Young Women in Rural South Africa: Developing a Cohort for Intervention Trials

High HIV Incidence and Prevalence Among Young Women in Rural South Africa: Developing a Cohort for Intervention Trials

High HIV Incidence and Prevalence Among Young Women in Rural South Africa: Developing a Cohort for Intervention Trials

To measure prevalence and model incidence of HIV infection. 2013 consecutive pregnant women attending public sector antenatal clinics in 1997 in Hlabisa health district, South Africa. Historical seroprevalence data, 1992-1995. Serum remaining from syphilis testing was tested anonymously for antibodies to HIV to determine seroprevalence. Two models, allowing for differential mortality between HIV-positive and HIV-negative people, were used. The first used serial seroprevalence data to estimate trends in annual incidence. The second, a maximum likelihood model, took account of changing force of infection and age-dependent risk of infection, to estimate age-specific HIV incidence in 1997. Multiple logistic regression provided adjusted odds ratios (OR) for risk factors for prevalent HIV infection. Estimated annual HIV incidence increased from 4% in 1992/1993 to 10% in 1996/1997. In 1997, highest age-specific incidence was 16% among women aged between 20 and 24 years. In 1997, overall prevalence was 26% (95% confidence interval [CI], 24%-28%) and at 34% was highest among women aged between 20 and 24 years. Young age (<30 years; odds ratio [OR], 2.1; p = .001), unmarried status (OR 2.2; p = .001) and living in less remote parts of the district (OR 1.5; p = .002) were associated with HIV prevalence in univariate analysis. Associations were less strong in multivariate analysis. Partner's migration status was not associated with HIV infection. Substantial heterogeneity of HIV prevalence by clinic was observed (range 17%-31%; test for trend, p = .001). This community is experiencing an explosive HIV epidemic. Young, single women in the more developed parts of the district would form an appropriate cohort to test, and benefit from, interventions such as vaginal microbicides and HIV vaccines.

Antiretroviral drugs as a public health intervention for pregnant HIV-infected women in rural South Africa: an issue of cost-effectiveness and capacity.

To estimate cost-effectiveness and capacity requirements for providing antiretroviral drugs to pregnant HIV-infected women in rural South Africa. Hlabisa health district, where HIV prevalence among pregnant women was 26.0% in 1997. Calculation of the number of paediatric HIV infections averted under three scenarios, and their cost. No intervention was compared with scenario A (zidovudine delivered within current infrastructure), scenario B (zidovudine delivered through enhanced infrastructure), and scenario C (short-course zidovudine plus lamivudine delivered through enhanced infrastructure). Cost-effectiveness was defined as cost per infection averted and cost per potential life-year gained. Capacity was determined in terms of staff and infrastructure required to effectively implement the scenarios. With no intervention, 657 paediatric HIV infections were projected for 1997. In scenario A this could be reduced by 15% at a cost of US$ 574 825, in scenario B by 42% at US$ 1520770, and in scenario C by 47% at US$ 764901. In scenario C, drugs accounted for 76% of costs, whereas additional staff accounted for 18%. Cost per infection averted was US$ 2492 and cost per potential life-year gained (discounted at 3%) was US$ 88. Cost of scenario C was equivalent to 14% of the 1997 district health budget. At least 12 extra counsellors and nurses and one laboratory technician, together with substantial logistical and managerial support, would be needed to deliver an effective intervention. Although antiretrovirals may be relatively cost-effective in this setting, the budget required is currently unaffordable. Developing the capacity required to deliver the intervention would pose both a major challenge, and an opportunity, to improve health services.

Pregnant women as a reservoir of undetected sexually transmitted diseases in rural South Africa: implications for disease control.

This study was undertaken to determine the prevalence of sexually transmitted diseases (STDs) in pregnant women in rural South Africa and to determine the value of using abnormal urogenital symptoms to identify infected women. This was a cross-sectional study of 327 patients attending prenatal clinics. Of the 271 women with complete data, 141 (52%) had at least 1 STD and 49 (18%) had more than 1. Abnormal symptoms were common (n = 225; 83%), but associations were weak, and the positive predictive value of different symptoms for infection ranged from 2% to 54%. Most STDs in rural South African women remain undetected and untreated. As the scope for laboratory diagnosis in resource-poor settings is limited, presumptive treatment of pregnant women and their partners may be a cost-effective option to reduce transmission of STDs and HIV infection.

Epidemiology of syphilis in pregnancy in rural South Africa: opportunities for control.

The paper describes the epidemiology, risk factors and impact on pregnancy outcome of syphilis in pregnant women in rural South Africa. Prevalence was determined from laboratory records. A case-control study of 200 women (50 cases with syphilis) was done to investigate possible risk factors. To determine the impact on pregnancy outcome, and to evaluate the effect of treatment, a retrospective cohort was constructed. Overall prevalence of syphilis was 6.5%; it was highest in the urban antenatal clinic (9%). The odds ratios for syphilis in women gravidity 3-5 compared to gravidity 6 was 3.2 and 2.3 compared to women with gravidity 2 or less. For women with a previous birth, those with a previous perinatal death were 3.2 times more likely to have syphilis after adjusting for other risk factors. Pregnancy outcome was available for 187 women. The adjusted odds ratio of an adverse pregnancy outcome in women with syphilis was 11.8. All still births occurred in women with syphilis. The prevalence of syphilis is high in this rural area and screening should be applied to all women. Although screening was comprehensive, less than half of the detected cases were fully treated and a poor perinatal outcome ensued. On-site testing for syphilis at the time of booking would allow treatment to start immediately.

Contraceptive Prevalence in Rural South Africa

Analysis is provided of data collected among a sample of 2290 women in the Transkei subregion of South Africa. The sample was a multistage probability sample stratified by socioeconomic group and region (8). The aim was to identify the main features of contraceptive behavior in the rural Transkei region which has 10% of the South African population and 55% of the Eastern Cape population. 46% of women headed households and 32% of the population were males aged 15-64 years. A notable feature of the region is widespread poverty and a lack of amenities. Survey findings reveal that 60% of women had ever used contraception. 42% of women were current users. Contraceptive knowledge was high but varied by background characteristics. 53% of never married women and 34% of currently married women were current users. 16% of uneducated women and 67% of educated women were current users. More users were women who worked outside the home. Marriage was viewed as not a good indicator of sexual practices. Over 70% of never married teenagers were sexually active of whom 68% were current users. 58% of current use was use of injectables and 29% used the pill. The condom was widely known but seldom used. Rhythm was the least well known and the least used method. It is confirmed that contraceptive use among Blacks in Transkei followed the national pattern of widespread use of effective modern methods of contraception. 43% indicated a stop to childbearing as the reason for use. 33% desired to space births. Common reasons for nonuse were sexual inactivity and desire for a pregnancy. The main reasons for discontinuation were a desire for a pregnancy being pregnant and husbands objection. 41% of women who never used intended to use a method in the future. It is posited that contraceptive use among rural women in South Africa is part of a socioeconomic adjustment strategy. Government family planning is not credited with the high demand for contraception due to client-unfriendly programs.